What happens when I am placed on the waiting list?

You will get put on the waiting list once:

  • Funding has been agreed
  • You have managed to maintain a stable weight
  • All assessments have been completed
  • The appropriate surgical procedure has been agreed with you

Group Education

You will receive a letter inviting you to a second Group Education.

This is a 1-2 hour group session attended by approximately 12 patients held in the Whittington Education Centre (WEC) behind the Jenner Building or in the N19 meeting room (at the back of the canteen).

The session is supported by a PowerPoint presentation and our aim is that people leave with a good understanding of the operations we offer, the benefits and risks, the implications on your life and diet and our pathway leading up to surgery.

There is also ample time allotted for questions.

You cannot progress to the next stage of the assessment without attending Group Education.

Pre-assessment appointment

This is usually about four weeks before surgery and carried out by the pre-assessment nurse.

Its purpose is to check that you are fit for surgery and an opportunity to ask any last minute questions. Blood tests and blood pressure are taken at this time. 

Your weight will be checked to make sure you are on target – your operation will be postponed if you are gaining weight. You will be given an information booklet on your surgery and be advised on the pre-op liver shrinkage diet.

The pre-operative liver shrinkage diet (PoLiSh)

Before your operation, it is important to follow a special pre-op diet to help prepare your body for the surgery.

Many people needing obesity surgery have a large fatty liver, which can make the operation technically difficult. Therefore it is necessary to follow a strict diet that is low in dietary carbohydrate and fat. This diet will encourage the body to use up glycogen stores (carbohydrate that is stored in the liver), thus helping to shrink the size of the liver. This diet should be strictly followed for at least 3-4 weeks prior to surgery.

It is essential to follow this diet; otherwise the liver could bleed heavily during surgery or there could be injury to organs. If this happens, the surgeon may have to do open surgery, instead of a laparoscopic procedure. However, in most cases the surgeons will simply pull out and postpone the surgery.

You should use this period of time as a great opportunity to kick-start your weight loss and also to help get into the habit of eating a healthy diet. If you continue to eat this way after the surgery you will manage to successfully reach your weight loss targets. Also the more weight you lose before the surgery the better, as it helps to reduce the risk related to surgery.

Nutrition Physician review and Cambridge Diet

In some cases, people are able to avoid a two-stage operation or improve their operative risks by being referred to the Nutrition Physician. Typical patients who see our nutrition physician are those with a BMI above 55 kg m2 or those who carry most of their weight around their abdomen.

After a thorough assessment, he will make recommendations for a particular Cambridge diet plan. This varies for each person in terms of calorie provision, length of prescription, liquid only or combination. You will be allocated a local Cambridge diet counsellor who will see you on a weekly basis.

There should not be a gap between you following this diet and your surgery, which prevents any weight regain which may happen otherwise.

Admission for surgery

You may be given tablets on the evening before surgery and on the morning of admission to reduce the likelihood of aspirating stomach acid. You may be given an injection on the morning of admission to reduce the risk of developing life-threatening clots in your veins or your lungs (thromboembolism and PE) though your surgeon may choose to give it only after the operation. You may also be asked to avoid taking some of your medicines by the pre-assessment nurses.

The surgical team and the anaesthetists will see you prior to surgery. They will confirm that you are willing to undergo surgery, all preparations are complete and it is safe to proceed with your operation. They will also confirm that an appropriate facility (High Dependency Unit or specialist ward) is available for you to recover after surgery. Rarely, due to unexpected emergency admissions, the requested beds are not available – your operation will then be rescheduled for another date.

You will be taken into the theatre and general anaesthesia will be administered on the operating table.

What happens in hospital after surgery
Higher risk patients will need to stay overnight in the High Dependency Unit. A nurse will look after them on a 1:1 basis, with other duty doctors available on the unit. Otherwise you will go straight to the ward – we try to keep most of our patients on Mercers Ward. Nurses on the general ward will look after all other patients. They will seek advice from doctors if there is a need to do so. The surgical team will visit you once a day and in case of difficulties, as and when required. You may be prescribed oral painkillers with injections for back up. Alternatively, you may be provided with a system that will allow you to self-administer effective painkillers safely (Patient Controlled Analgesia) – this involves setting up a pump to administer small amounts of morphine in to your vein when you press a button in your hand. The anaesthetists and the pain team may visit you to ensure that your pain control and breathing is satisfactory.

Patients with sleep apnoea will be supported with CPAP (Continuous Positive Airway Pressure). If you use a machine at home then you must bring it in with you.

Specialist bariatric equipment such as beds and chairs etc. are available to facilitate early mobilisation, which is crucial.

Your length of hospital stay will most likely be 1-3 days, depending on your surgeons’ preference and also your physical status; in general if you are a higher risk patient then you may stay in a bit longer. Below is a guide, however please note that this can vary if there are any post-operative complications:
  • Gastric Bands – Day case or overnight
  • Sleeve or Bypass (Roux-en-Y or Single Anastomosis) – 1-3 nights stay; may include first night in a High Dependency Unit.

You will normally be allowed to drink any fluids from the day after surgery – you should avoid sugary and fizzy drinks. After surgery all medications should be taken in soluble or liquid form for the 1st few months after a sleeve or bypass or lifelong after gastric banding – if these forms are not available then consult your pharmacist or GP to check if your medicine can be crushed. You will be given a supply of your medications to go home with. You will be expected to sit up within an hour and begin mobilising soon after your operation on the day of the surgery.

You will be seen by the Bariatric Nurse specialist, who will give you a contact number if there are any problems or if you need any advice. The Bariatric Dietitian will see you before you leave hospital, and provide you with dietary advice following surgery.

Initially, it will be necessary to take liquids for 2 weeks, soft moist food for 2 weeks and then gradually progress towards normal food.

Working on it!